The Impact of Age on the Incidence and Prevalence of Moderate to Severe Cellular Rejection Detected by Routine Surveillance Biopsy in Pediatric Heart Transplantation

Zinn, Matthew D.; Simpson, K.E.; Wallendorf, Mike; Osborne, A.D.; Kirklin, James K.; Canter, Charles E.

doi:10.1016/j.healun.2016.01.1160

Cited by 9 publications

(16 citation statements)

References 13 publications

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“…Notably, in pediatric patients late retransplantation was associated with increased all-cause mortality. This discrepancy may be related to increased risk of late rejection in this group, 27 or there may be different influencing posttransplant pediatric outcomes that were not accounted for in our analysis. However, our results were similar in the sensitivity analyses of adult patients as well as the most recent time periods.…”

Section: Figurementioning

confidence: 89%

Outcomes in patients undergoing cardiac retransplantation: A propensity matched cohort analysis of the UNOS Registry

Miller

Clarke

Howlett

et al. 2019

The Journal of Heart and Lung Transplantation

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BACKGROUND: Cardiac retransplantation accounts for approximately 3% of cardiac transplantation and is considered a risk factor for increased mortality. However, factors inherent to retransplantation including previous sternotomy, sensitization, and renal dysfunction may account for the increased mortality. We assessed whether retransplantation was associated with all-cause mortality after adjusting for such patient risk factors. METHODS: We conducted a retrospective cohort study of adult and pediatric patients enrolled in the United Network for Organ Sharing database. We identified patients undergoing cardiac retransplantation based on transplant listing diagnosis and history of previous transplant. We used propensity-score matching to identify a matched cohort undergoing initial heart transplantation. RESULTS: In total, 62,112 heart transplant recipients were identified, with a mean age 46.6 § 19.1 years. Of these, 2,202 (3.4%) underwent late cardiac retransplantation (>1 year after initial transplant and not for acute rejection). Compared with a matched group of patients undergoing initial heart transplantation, patients undergoing late retransplantation had comparable rates of all-cause mortality at 1 year (13.6% vs 13.8%, p = 0.733). In addition, overall mortality was not significantly different after matching (unadjusted hazard ratio [HR] 1.08, p = 0.084). In contrast, patients undergoing retransplantation within 1 year of initial transplant or for acute rejection remained at increased risk of mortality posttransplant after similar matching (unadjusted HR 1.79, p < 0.001). CONCLUSIONS: After matching for comorbidities, late retransplantation in the adult population was not associated with an increase in all-cause mortality. Our findings highlight the importance of assessing indication acuity and comorbid conditions when considering retransplant candidacy.

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Section: Figurementioning

confidence: 89%

Outcomes in patients undergoing cardiac retransplantation: A propensity matched cohort analysis of the UNOS Registry

Miller

Clarke

Howlett

et al. 2019

The Journal of Heart and Lung Transplantation

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“…27 As shown in Table 2, there was no difference in the distribution of rejection by age in the first year post-transplant, which is dissimilar from registry reports where rejection in infants is expected to be less common compared to adolescents. 28 However, while a relatively high percentage of our heart transplant recipients are less than 12 months (48%), there is a large proportion (67%) with congenital heart disease which could have imposed a higher rejection risk in these younger patients. If the rejection rate was lower in our infant population, then one can conjecture that it is because of fewer endomyocardial biopsies in our protocol, but the opposite was found.…”

Section: Discussionmentioning

confidence: 97%

Outcomes of low-intensity biopsy surveillance for rejection in paediatric cardiac transplantation

Evers¹,

Jorgensen

Hong

et al. 2019

Cardiol Young

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Background:Significant inter-centre variability in the intensity of endomyocardial biopsy surveillance for rejection following paediatric cardiac transplantation has been reported. Our aim was to determine if low-intensity biopsy surveillance with two scheduled biopsies in the first year would produce outcomes similar to published registry outcomes.Methods:A retrospective study of paediatric recipients transplanted between 2008 and 2014 using a low-intensity biopsy protocol consisting of two surveillance biopsies at 3 and 12–13 months in the first post-transplant year, then annually thereafter. Additional biopsies were performed based on echocardiographic and clinical surveillance. Excluded were recipients that were re-transplanted or multi-organ transplanted or were followed at another institution.Results:A total of 81 recipients in the first 13 months after transplant underwent an average of 2 (SD ± 1.3) biopsies, 24 ± 6.8 echocardiograms, and 17 ± 4.4 clinic visits per recipient. During the 13-month period, 19 recipients had 24 treated rejection episodes, with the first at an average of 2.8 months post-transplant. The 3-, 12-, 36-, and 60-month conditional on discharge graft survival were 100%, 98.8%, 98.8%, and 90.4%, respectively, comparable to reported figures in major paediatric registries. At a mean follow-up of 4.7 ± 2.1 years, four patients (4.9%) developed cardiac allograft vasculopathy, three (3.7%) developed a malignancy, and seven (8.6%) suffered graft loss.Conclusion:Rejection surveillance with a low-intensity biopsy protocol demonstrated similar intermediate-term outcomes and safety measures as international registries up to 5 years post-transplant.

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“…Despite alternative methods of rejection surveillance, most rejection episodes (81.6%) are still diagnosed by routine surveillance EMB in the current era. 1 There is a theoretical risk of cardiac perforation and TV injury after EMB. Smaller pediatric reports have reported low risk associated with EMB.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Percutaneous transvenous EMB remains the gold standard for monitoring for graft rejection after heart transplantation. Despite alternative methods of rejection surveillance, most rejection episodes (81.6%) are still diagnosed by routine surveillance EMB in the current era . There is a theoretical risk of cardiac perforation and TV injury after EMB.…”

Section: Introductionmentioning

confidence: 99%

Utility of screening echocardiogram after endomyocardial biopsy for identification of cardiac perforation or tricuspid valve injury

Peng

Kipps

Palmon

et al. 2018

Pediatric Transplantation

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Per protocol, our institution obtains echocardiograms immediately after each EMB to rule out procedural complication. We sought to determine the incidence of echocardiogram-detected cardiac perforation and TV injury and to evaluate the utility of routine screening echocardiogram after each EMB in the current era. At a single center, 99% (1917/1942) EMB performed in 162 patients were immediately followed by an echocardiogram per protocol. There were five newly diagnosed pericardial effusions, and only one required pericardiocentesis. In the three echocardiograms demonstrating new flail TV, only one patient underwent surgical repair 2 months later. This study demonstrates the very low incidence of significant hemopericardium and TV injury after EMB in pediatric heart transplant recipients and argues against the utility of post-EMB echocardiograms to screen solely for procedural complications.

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The Impact of Age on the Incidence and Prevalence of Moderate to Severe Cellular Rejection Detected by Routine Surveillance Biopsy in Pediatric Heart Transplantation

Cited by 9 publications

References 13 publications

Outcomes in patients undergoing cardiac retransplantation: A propensity matched cohort analysis of the UNOS Registry

Outcomes in patients undergoing cardiac retransplantation: A propensity matched cohort analysis of the UNOS Registry

Outcomes of low-intensity biopsy surveillance for rejection in paediatric cardiac transplantation

Utility of screening echocardiogram after endomyocardial biopsy for identification of cardiac perforation or tricuspid valve injury

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